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Tri-Agency Facilities and Field Use Request Form

  1. Tri-Agency Facilities/Field Rquest Form
  2. Cheney Parks Logo
  3. Please tell us what agency you are with.
  4. Please upload any advertisements you will be sending out via email, social media, & etc.
  5. Please describe your event.
  6. Will food be served?
  7. Will beverages be served?
  8. Please include setup and clean up in your times.
  9. Alcohol or Tabacco is prohibited on City properties.
  10. Will your agency be charging for this event or activity that will allow you to generate revenue in excess of the operational costs of the activity?
  11. Will this event or activity be led by an employee of your organization, acting in his or her employment capacity?
  12. I understand that my agency may be charged for staff cost if a facility or field monitor is required.
  13. The undersigned will comply with the policies and regulations established by the other Agency for the use of facilities and fields. Further, undersigned agrees and promises to hold other Tri-Agency member, its employees, officers, and directors harmless from a liability for any and all injuries and/or damages to any person or property arising out of the use of the buildings, grounds, facilities and equipment during the use thereof by the undersigned.*
  14. Electronic Signature*
    By checking the "I agree" box, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  15. Leave This Blank:

  16. This field is not part of the form submission.